Department of Urology, Changhai Hospital of Shanghai, Shanghai, 200433, China.
World J Urol. 2023 Jul;41(7):1921-1927. doi: 10.1007/s00345-023-04426-8. Epub 2023 May 27.
To develop an objective and easily recognizable model to predict septic shock following percutaneous nephrolithotomy (PCNL).
First, we identified differences between 431 patients who underwent PCNL with or without septic shock. These data were used to develop existing models and examine their improvement. Multivariate analysis was applied to identify risk factors of septic shock after PCNL based on the scores allocated to the PCNL postoperative test indicators. Finally, we developed a predictive nomogram using the selected factors and compared its performance with that of the existing nomograms SOFA, qSOFA, and SIRS.
Twelve (2.8%) of the patients met the criteria for postoperative septic shock after PCNL. Baseline data analysis revealed differences in sex, preoperative drainage, urinary culture, and urinary leukocyte between groups. After transforming patient data into measurement-level data, we investigated each index score in these conditions, and found that the incidence of septic shock generally increased with the score. Multivariate analysis and early optimization screening revealed that septic shock factors could be predicted using platelets, leukocytes, bilirubin, and procalcitonin levels. We further compared the prediction accuracy of urinary calculi-associated septic shock (UCSS), SOFA, qSOFA, and SIRS scores using the AUC of the ROC curve. As compared to SIRS [AUC 0.938 (95% CI 0.910-0.959)] and qSOFA [AUC 0.930 (95% CI 0.901-0.952)], UCSS [AUC 0.974 (95% Cl 0.954-0.987)] and SOFA [AUC 0.974 (95% CI 0.954-0.987)] scored better at discriminating septic shock after PCNL. We further compared the ROC curves of UCSS with SOFA (95% CI - 0.800 to 0.0808, P = 0.992), qSOFA (95% CI - 0.0611 to 0.0808, P = 0.409), and SIRS (95% CI - 0.0703 to 0.144, P = 0.502), finding that UCSS was non-inferior to these models.
UCSS, a new convenient and cost-effective model, can predict septic shock following PCNL and provide more accurate discriminative and corrective capability than existing models by including only objective data. The predictive value of UCSS for septic shock after PCNL was greater than that of qSOFA or SIRS scores.
建立一种客观、易于识别的模型，以预测经皮肾镜碎石术（PCNL）后发生脓毒症休克的风险。
首先，我们比较了 431 例行 PCNL 术的患者，这些患者中有 431 例患者发生了脓毒症休克。基于 PCNL 术后检测指标的评分，应用多变量分析确定 PCNL 术后发生脓毒症休克的危险因素。最后，我们选择了一些因素，建立了一个预测列线图，并与现有的 SOFA、qSOFA 和 SIRS 列线图进行了比较。
12 例（2.8%）患者术后发生 PCNL 相关脓毒症休克。基线数据分析显示，两组患者的性别、术前引流、尿培养和尿白细胞计数存在差异。将患者数据转化为计量水平数据后，我们对这些条件下的每个指标评分进行了研究，发现脓毒症休克的发生率通常随着评分的增加而增加。多变量分析和早期优化筛选发现，血小板、白细胞、胆红素和降钙素水平可以预测脓毒症休克的发生。我们进一步通过 ROC 曲线的 AUC 比较了尿石症相关脓毒症休克（UCSS）、SOFA、qSOFA 和 SIRS 评分的预测准确性。与 SIRS[AUC 0.938（95%CI 0.910-0.959）]和 qSOFA[AUC 0.930（95%CI 0.901-0.952）]相比，UCSS[AUC 0.974（95%Cl 0.954-0.987）]和 SOFA[AUC 0.974（95%Cl 0.954-0.987）]在鉴别 PCNL 后发生的脓毒症休克方面表现更好。我们进一步比较了 UCSS 与 SOFA（95%CI-0.800 至 0.0808，P=0.992）、qSOFA（95%CI-0.0611 至 0.0808，P=0.409）和 SIRS（95%CI-0.0703 至 0.144，P=0.502）的 ROC 曲线，发现 UCSS 并不劣于这些模型。
UCSS 是一种新的简便、经济有效的模型，可以预测 PCNL 后发生脓毒症休克的风险，并通过纳入仅客观数据，提供比现有模型更准确的鉴别和校正能力。与 qSOFA 或 SIRS 评分相比，UCSS 对 PCNL 后脓毒症休克的预测价值更高。
